创伤性截肢患者术前决策冲突现状及影响因素分析  

The status quo of preoperative decisional conflict and its influencing factors in patients with traumatic amputation

作　　者：张欣欣 韩国杰 陈倩[1] 王艺文 李西娟[1] 柴宇霞[1] Zhang Xinxin;Han Guojie;Chen Qian;Wang Yiwen;Li Xijuan;Chai Yuxia(Emergency Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;School of Nursing and Health,Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院急诊医学科,郑州450052 [2]郑州大学护理与健康学院,郑州450000

出　　处：《中华现代护理杂志》2024年第35期4849-4855,共7页Chinese Journal of Modern Nursing

基　　金：河南省医学科技攻关省部共建重点项目(SBGJ202102086)。

摘　　要：目的调查创伤性截肢患者术前决策冲突现状并分析其影响因素,为构建针对性决策辅助方案提供参考。方法采用便利抽样法,选取2022年1月-2023年10月在郑州大学第一附属医院急诊科住院的189例创伤性截肢患者为调查对象。采用社会人口学资料调查表、中文版决策冲突量表、决策参与量表及领悟社会支持量表进行横断面调查,使用SPSS25.0软件对数据进行统计分析。结果共发放196份问卷,回收189份有效问卷,有效回收率96.4%。189例创伤性截肢患者术前决策冲突得分为(44.32±9.27)分;术前决策参与过程中,69例(36.5%)期待共享型决策,但实际参与角色中有100例(52.9%)为被动型。多重逐步回归分析结果显示,患者术前决策冲突的主要影响因素有年龄、文化程度、职业、家庭收入、实际参与角色、家庭支持(调整后R^(2)=0.799,P<0.01)。结论创伤性截肢患者术前实际参与角色和期望角色之间存在差异,术前决策冲突水平较高,并存在多个影响因素。医务人员应着重关注农民、年龄大、文化水平低和家庭收入较低的患者,尊重患者决策意愿,为患者提供适当的决策支持。Objective To investigate the status quo of preoperative decisional conflict in patients with traumatic amputation,analyze its influencing factors,and provide a reference for the development of targeted decision-making support programs.Methods Totally 189 patients with traumatic amputation hospitalized in the Emergency Department of the First Affiliated Hospital of Zhengzhou University from January 2022 to October 2023 were selected by convenience sampling.Data were collected using a sociodemographic questionnaire,the Chinese version of the Decision Conflict Scale(DCS),the Control Preference Scale(CPS),and the Perceived Social Support Scale(PSSS).Data analysis was performed using SPSS 25.0.Results A total of 196 questionnaires were distributed,with 189 valid responses,yielding an effective response rate of 96.4%.The average preoperative decisional conflict score among the 189 patients was(44.32±9.27).During the decision-making process,69 patients(36.5%)preferred a shared decision-making model,but 100 patients(52.9%)experienced a passive role.Multiple stepwise regression analysis indicated that the primary factors influencing decisional conflict were age,educational level,occupation,family income,actual participation role,family support(adjusted R^(2)=0.799,P<0.01).Conclusions There is a discrepancy between the expected and actual participation roles in the decision-making process among patients with traumatic amputation,leading to a high level of preoperative decisional conflict.Several factors contribute to this conflict.Healthcare providers should pay particular attention to peasants,older patients,those with lower education and family income,respect patients'control preferences,and provide appropriate decision-making support.

关 键 词：创伤 截肢术 决策参与 决策冲突 社会支持 影响因素 

分 类 号：R658.1[医药卫生—外科学]